Internal administration documents reveal that up to 51% of employers may have to relinquish their current health care coverage because of ObamaCare.

Small firms will be even likelier to lose existing plans.

The "midrange estimate is that 66% of small employer plans and 45% of large employer plans will relinquish their grandfathered status by the end of 2013," according to the document.

In the worst-case scenario, 69% of employers — 80% of smaller firms — would lose that status, exposing them to far more provisions under the new health law.

The 83-page document, a joint project of the departments of Health and Human Services, Labor and the IRS, examines the effects that ObamaCare's regulations would have on existing, or "grandfathered," employer-based health care plans.

Draft copies of the document were reportedly leaked to House Republicans during the week and began circulating Friday morning. Rep. Bill Posey, R-Fla., posted it on his Web site Friday afternoon.

"It's been passed around the staffs here on Capitol Hill. Congressman Posey thought it was important enough to share," said spokesman George Cecala.

In a statement, Posey said the document showed that the arguments in favor of ObamaCare were a "bait and switch."

"The president promised repeatedly that people who like their current plans can keep them, but now the details of their plan actually confirm what many suspected all along, most Americans will lose their current health care plan," Posey said.

A White House official told IBD: "This is a draft document, and we will be releasing the final regulation when it is complete. The president made a promise to the American people that if they liked their health care plan, they can keep it. The regulation, when finalized, will uphold that promise."

However, the source conceded: "It is difficult to predict how plans and employers will behave in the coming years, but if plans make changes that negatively impact consumers, then they will lose their grandfather status."

It's unclear how the document leaked out. An HHS spokeswoman confirmed that the department was working on a draft paper about grandfathered plans but said it hasn't been made public yet.

A House Republican staffer said the rumor was that the document had been erroneously posted on the Office of Management and Budget Web site earlier in the week and somebody spotted it before it was taken down. IBD has not been able to confirm this report.

Under the new health law, current employer-based health plans will be grandfathered — that is, they will not have to follow many Obama-Care provisions that take effect on Jan. 1, 2014. These include benefit mandates, caps on out-of-pocket expenses and limits on age-based premiums.

But they forfeit that grandfathered status if they make changes to the plans by 2014. If so, firms may have to adopt new plans or drop coverage and pay the penalty.

No Longer A Grandfather

But the term "grandfathered" is loosely defined by the new law; specifics have been left up to the bureaucracies. One key question is, how much flexibility would employers have in changing their coverage before it is no longer considered grandfathered?

Under the regulations in the document, a plan is no longer considered to be grandfathered if:

• It eliminates benefits related to diagnosis or treatment of a particular condition.

• It increases the percentage of a cost-sharing requirement (such as co-insurance) above its level as of March 23, 2010.

• It increases the fixed amount of cost-sharing such as deductibles or out-of-pocket limits by a total percentage measured from March 23, 2010, that is more than the sum of medical inflation plus 15 percentage points.

• It increases co-payments from March 23, 2010, by an amount that is the greater of: medical inflation plus 15 percentage points or medical inflation plus $5.

• The employer's share of the premium decreases more than 5 percentage points below what the share was on March 23, 2010.

Analyzing data on employer-provided plans from 2008 and 2009, the report stated: "Many employers who made changes between 2008 and 2009 that would have caused them to relinquish grandfather status did so based on exceeding one of the cost-sharing limits."

In total, 66% of small businesses and 47% of large businesses made a change in their health care plans last year that would have forfeited their grandfathered status.

"These rules will ensure that up to 69% of employees — and 80% of workers in small business — will lose their current plan within three years," said Rep. Phil Gingrey, R-Ga., a physician. "The reality is this: 58% of Americans want ObamaCare repealed because they fear they will lose their health care — and even their jobs — once this law is fully implemented."

At this point I really don't think that the Sup Ct. is the final straw on this plan:

1) It still has to go through appropriations to be funded, and that is going to be MUCH tougher after November.

2) I think there is a strong possibility that the law gets repealed. I realize that it would take a super majority in the Senate, but I doubt that ANY politician would want to even ATTEMPT to filibuster a bill to repeal this crappy law. They're seeing what its doing for the people that voted on it, I doubt they would want to jump under that bus as it goes by the 2nd time.

For the first time since I have been allowed to vote I will be voting AGAINST Carl Levin, due to the fact that he voted FOR the UH bill that he KNEW we opposed.

As Kent York eloquently (not!) stated to U.S. Rep. Bill Sarpalius "We didn't send you to Washington to make intelligent decisions. We sent you to represent us!" They need to be reminded that they are a government of the people BY the people. They get their power from us, and they are supposed to act on our behalves. Send a big reminder and vote out all that disobeyed.

President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.

As events are now unfolding, the Massachusetts plan couldn't be a more damning indictment of ObamaCare. The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.

In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."

In April, Mr. Patrick's insurance commissioner had rejected 235 of 274 premium increases state insurers had submitted for approval for individuals and small businesses. The carriers said these increases were necessary to cover their expected claims over the coming year, as underlying state health costs continue to rise at 8% annually. By inventing an arbitrary rate cap, the administration was in effect ordering the carriers to sell their products at a loss.

Mr. Patrick has promised to appeal the panel's decision and find some other reason to cap rates. Yet a raft of internal documents recently leaked to the press shows this squeeze play was opposed even within his own administration.

In an April message to his staff, Robert Dynan, a career insurance commissioner responsible for ensuring the solvency of state carriers, wrote that his superiors "implemented artificial price caps on HMO rates. The rates, by design, have no actuarial support. This action was taken against my objections and without including me in the conversation."

Mr. Dynan added that "The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system" and that "there most likely will be a train wreck (or perhaps several train wrecks)."

Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.

The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.

In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the "individual mandate"—buying insurance only when they are about to incur major medical costs, then dumping coverage—has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)

Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."

One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."

An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question—for Massachusetts, and now for the nation—is whether that was really the plan all along.

"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.

He went on to explain that universal coverage was "fundamentally a political strategy question"—a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."

In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick's price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.

Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers—presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state "determination of need" process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.

Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.

All of this is merely a prelude to far more aggressive restructuring of the state's health-care markets—and a preview of what awaits the rest of the country.

In other news, the 10% tax on tanning salons has now taken effect. Is that the most racist tax ever or what?

Sarah Palin Outs Darth VaderBy Stuart SchwartzDarth Vader is out of the closet...and we have Sarah Palin to thank.

The intrepid crusader from the north cut to the heart of Obamacare a year ago, slashing through the professor-speak and government gobbledygook with a searing summary on Facebook of its bottom line: "death panels." With those words, the grounds for debate had shifted, the mainstream media ideological blackout was circumvented, and now, although it may have been Obama's new head of Medicare, Harvard's Dr. Donald Berwick, who stepped on the shuttle at Boston's Logan International Airport, it is Darth Vader who has exited at Reagan National.

Darth Vader -- really? The man responsible for the death of a gazillion inhabited worlds, through whom the evil Emperor Palpatine -- described as " a middle-aged politician ... who gains power through deception and treachery"...sound familiar? -- sought to enslave the universe in the fictional Star Wars saga? Surely, an exaggeration! Yes, and deliberately so, for Berwick starts off his gig as head of the Centers for Medicare and Medicaid as an enthusiastic proponent of, as one British media commentator noted, a system that routinely denies "some poor suffering victim a remedy that is available in other countries." At the same time, it views the elderly as simply less worthy of care, an expendable segment of the population for whom doctors and heart specialists provide less treatment past the official "cut-off" of 65 years, a British health research journal documented.

Palin's column on death panels ignited a firestorm of elite media and beltway criticism. Once, that would have been enough to shut down debate, for the broadcast networks and newspapers controlled information -- we knew only what they wanted us to know. Suddenly, the new media (including the site you're now reading) provided reality, and the Tea Parties and Republican Party followed. And now Darth Vader has become a metaphor, a figure of speech signifying that the coming of Harvard's Berwick represents the same thing to the average American that the arrival of the Death Star, the spaceship used to destroy planets, meant for entire populations. All of a sudden, life-and-death decisions are out of our hands, resting with a government determined to control every waking moment of our lives.

As Investors Business Daily headlined, "The President's One-Man Death Panel" has arrived. Berwick has come to Washington to play Vader to Obama's Emperor Palpatine. The Harvard health specialist's job is to transform Medicare, to make the primary medical insurance system for seniors into an instrument of social policy, to take wealth and years from seniors and redistribute them to favored segments of the population. This is not about health care, and it is especially not about seniors; rather, it is all about the social engineering.

Sarah Palin was right, stubbornly hanging in when the mainstream media -- sensing "a great disturbance in the [leftist] force" -- trained its batteries on her. She was ridiculed on network newscasts, in the White House briefing room, by the media "stormtroopers [who] represented the most visible extension of Imperial [Obama] might." Darth Vader and Star Wars serve as metaphor, Palin as Princess Leia, while network anchors, commentator after commentator, all the president's men showered ridicule on her. "Downright evil," screamed Keith Olbermann; "stupid as s**t," proclaimed a popular Democratic blog.

But she persevered, and the truth emerged. The president and his congressional allies were forcing a crazy quilt of statist bureaucracies, socialist dysfunctions, and authoritarian controls. Each day brought more revelations as Tea Party activists, Republican staffers, ordinary citizens, and new media combed through Obamacare legislation. Sarah Palin was right. Popular radio host Mark Levin put it best: "Sarah Palin's not scary. You know who is? Barack Hussein Obama."

Reality had settled in, so much so that the president circumvented the public legislative process and made a recess appointment of Berwick. He hoped to avoid discussion of the views of the Harvard leftist, who, the New York Post pointed out, is a "fervent ideologue [who] puts social engineering ahead of the individual patient's needs." The Berwick view: Good health care must take from the wealthy and the well, the seniors and those less desired by society, and "redistribute" so as to achieve a "just, equitable, civilized and humane" republic of the people.

Berwick is part of a university health policy establishment that grew out of its original mission to train practitioners in the medical field. They did their job well, providing the United States with health care that, for all of its problems, is the best health care system in the world. But then a disease set in, the same disease that produced Barack Obama and his government-by-professor -- the hubris of an educated class that, as economist Thomas Sowell notes, is "not only wrong, but grossly and disastrously wrong in their prescriptions for the ills of society."

Health policy schools began popping up, as Ivy League universities led the way in thinking of health services as a means to change society. This is known as "policy," and medical schools were soon accompanied by whole schools of health policy. Professors were not content to produce world-class medical professionals; instead, they wanted to change the United States, telling you what you could and could not do in all matters touching upon health. It was as if your plumber suddenly said, "Enough with the plumbing!" and seized control of your life, telling you what type of fixtures are to be allowed in your house, dictating the meals that would ultimately emerge as waste, regulating the number and type of bathrooms permitted...you get the picture.

But with Berwick and his colleagues, it gets worse. He is associated with Physicians for a National Health Program (PNHP), which is the medical world's equivalent of the leftist community activist group ACORN. PNHP has provided the bodies to fill the white coats on display at Obamacare publicity opportunities and has ties to both elite public health schools (its president is an administrator and professor at the Cornell medical school) and a variety of socialist and communist organizations in vogue in academia (Students for a Democratic Society, the Communist Party, Democratic Socialists of America, etc. -- see Discover the Networks). Their shared goal: replace individual choice with centralized government control.

In the end, it is about power. Donald Berwick and Barack Obama, Darth Vader and Emperor Palpatine want to dictate the care you can and can't have. Berwick, for example, calls ultrasounds and cesarean sections a "form of assault and battery." Under Obamacare, he (through his rationing bureaucracy), not you or your doctor, decides whether you have a procedure. This is nothing new -- the political systems and policy bureaucracies Berwick and Obama seek to emulate have been doing it with disastrous results for individuals for years (e.g., England, Cuba, the old Soviet Union, Hitler's Germany). As one senior staff member at Berwick's base in the Harvard School of Public Health has put it so eloquently in his blogs and books, we will do away with a Constitution and government that are the "enemy of the working class."

But Palin and the Tea Parties, the new media, and finally, a newly energized Republican Party have seen through the rhetoric. They see that when it came time for his wife to be treated for a debilitating illness, Donald Berwick went outside the system he was part of, Boston media revealed, and "used his many connections to get her the best care possible." But this is the way of Obama's Washington, of Berwick's Harvard Square, and the mainstream media's Upper Manhattan...of Darth Vader's empire.

Good for thee, but not for me. Darth Vader is out of the closet, and the Death Star has entered orbit.

The Serious Tracking of Americans Begins They have passed the health bill, they have passed the financial regulations bill and they have snuck stuff into the stimulus package bills. They are going to track your money and your body. Here's the first few things they are doing. This is step one. It will only get worse from here.

According numismaster.com:

...the Health Care Bill mandates, according to Numismaster.com, Starting on January 1st in 2012, S federal law will require coin and bullion dealers to report to the Internal Revenue Service all gold and silver coin purchases and sales greater than $600.

No that is not an error, they tacked the gold coin tracking regulations into the health bill. They are just tacking stuff on wherever they can.

As for your body, you will be required to have an "electronic health record", by 2014. They snuck this into one of the "stimulus" bills. The electronic record will include an obesity rating. The information will be required to be on a "national exchange" with only secure access (Hah!). Why the F does your obesity rating have to be on a national exchange? This is a tip off to how micro-managed they are going to attempt to run your life.

Keep in mind that the health bill and financial "reform" bill are thousands of pages, with much of the details left up to the new agencies to fill in. Obama is appointing major league interventionists to head these agencies. They are completely clueless as to how an economy works. Their regs will be over the top. It will stifle America in so many ways, it is difficult to imagine. I was in East Berlin the year before the Wall came down. I saw what constant monitoring and micro-management did to people. It is not pretty. The gray, the drab, the despair was everywhere. When you can only take orders and wait for approvals and are constantly watched, it saps the life out of you. America is going to be changing and the government is going to try and watch you and monitor your vitals, as if you were a lab rat, as it does the changing.

I've known about this provision in the HCR bill, but I didn't know that a lawsuit had been filed:

Forbes wrote:

The Sleeper Lawsuit Against ObamaCare In TexasJuly 16, 2010 - 2:50 pmDavid Whelan is a staff writer at Forbes

The lawsuits against ObamaCare filed by state attorneys general have gotten a lot of attention, but there's another worth watching. Last month the Texas Spine & Joint Hospital, along with the Physician Hospitals of America trade group, filed suit against Kathleen Sebelius. The hospital, based in Tyler, Tex., claims that the language in the Affordable Care Act (aka health reform) banning physicians from owning hospitals is unconstitutional.

I've argued over and over again that doctors who treat patients should be able to own hospitals. Accountants own their CPA firms and lawyers own law firms. Why should non-physicians have a monopoly on running hospitals? It strikes me as bad public policy, since doctors should know better than most what makes a good hospital. There's also a track record of these hospitals producing better clinical results than the non-specialized hospitals they compete with. For a backgrounder on this issue, check out "Stop That Patient," my cover story on the controversy.

The lawsuit could to trial as early as December. If it succeeds, could it lead to a groundswell of others that chip away at the 2,000 page health bill?It's unclear how seriously to take the claims that the clause against specialty hospitals is unconstitutional. There's already a set of laws on the books, called Stark, that prevent doctors from investing in certain kinds of labs and imaging facilities. Given that this law has been in effect for almost 20 years, it seems difficult to say that a new law adding hospitals to that list would suddenly be unconstitutional. We raised this Physicians Hospitals of America executive director Molly Sandvig, who said, by email:

"First, the constitutionality of the Stark law has never been specifically questioned. Second, to take away a right that existed by law, upon which physicians could rely, Congress needs a rational basis. We're contending their was not rational basis because physician hospitals are better all around and don't damage the existing healthcare system (all the usual arguments). It is a violation of the 5th amendment right to due process and equal protection to remove a previously granted right without a rational basis."

The PHA also argues that the law will have a significant economic impact both on local economies and on tax revenues. Physician-owned hospitals employ 75,000 workers and pay on average $3 million in taxes per facility--compared to none by 85% of hospitals that have non-profit status.

The government hasn't weighed in yet, except to ask for more time. "Unfortunately there's nothing we can provide at this time in that this is a matter in litigation," says Charles Miller, a U.S. DOJ spokesman for the civil division.The attorney defending the case for Sebelius was not allowed to comment. A motion for summary judgment is scheduled for September and a trial could be as early as December, according to Physican Hospitals of America executive director Molly Sandvig.

This little rule, within ObamaCare, is another way that the legislation cuts down on patient choice. Using the market power of Medicare, the White House and Congress are essentially shutting down a business it doesn't like for political reasons. It's not a good precedent for patients who would like more options, not fewer.

Insurers Push Plans Limiting Patient Choice of Doctors Sandy Huffaker for The New York Times By REED ABELSONPublished: July 17, 2010

As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals.

The plans, being tested in places like San Diego, New York and Chicago, are likely to appeal especially to small businesses that already provide insurance to their employees, but are concerned about the ever-spiraling cost of coverage.

But large employers, as well, are starting to show some interest, and insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. That could come as a surprise to many who remember the repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices.

But companies may be able to reduce their premiums by as much as 15 percent, the insurers say, by offering the more limited plans.

Many insurers also expect the plans to be popular with individuals and small businesses who will purchase coverage in the insurance exchanges, or marketplaces that are mandated under the new health care law and scheduled to take effect in 2014.

Tens of millions of everyday Americans will buy their coverage through those exchanges, a vast pool of new customers, including many of the previously uninsured, whom insurers expect will be willing to accept restrictions to get a better deal.

“What this does is eliminate the Gucci doctors,” said Peter Skoda, the controller of the Haro Bicycle Corporation, a Vista, Calif., business that employs 30 people. Facing a possible 35 percent increase in its rates, Haro switched to an Aetna plan that prevents employees from seeing doctors at two medical groups affiliated with the Scripps Health system in San Diego. If employees go to one of the excluded doctors, they are responsible for paying the whole bill.

“There wasn’t any pushback,” Mr. Skoda said. Haro’s employees are generally young and healthy, he said, and they rarely go to the doctor. Instead, they want to make sure they have adequate coverage if they go to the emergency room.

The company’s premiums average $433 a month, Mr. Skoda said, with employees paying one-fourth of the expense. A few employees opted for more traditional coverage, enabling them to go where they please. But they are paying significantly higher deductibles and out-of-pocket costs that could add thousands of dollars to their medical bills.

The last time health insurers and employers sought to sharply limit patients’ choice was back in the early 1990s, when insurers tried to reinvent themselves by embracing managed care. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to.

“Back in the H.M.O. days, it was tight networks, and it did save money,” said Ken Goulet, an executive vice president at WellPoint, one of the nation’s largest private health insurers, which is experimenting with re-introducing the idea in California.

The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice. Prominent officials like Mr. Obama and Hillary Rodham Clinton learned to utter the word “choice” at every turn as advocates of overhauling the system.

But choice — or at least choice that will not cost you — is likely to be increasingly scarce as health insurers and employers scramble to find ways of keep premiums from becoming unaffordable. Aetna, Cigna, the UnitedHealth Group and WellPoint are all trying out plans with limited networks.

The size of these networks is typically much smaller than traditional plans. In New York, for example, Aetna offers a narrow-network plan that has about half the doctors and two-thirds of the hospitals the insurer typically offers. People enrolled in this plan are covered only if they go to a doctor or hospital within the network, but insurers are also experimenting with plans that allow a patient to see someone outside the network but pay much more than they would in a traditional plan offering out-of-network benefits.

The insurers are betting these plans will have widespread appeal in the insurance exchanges as individuals gravitate toward the least expensive options. “We think it’s going to grow to be quite a hit over the next few years,” said Mr. Goulet of WellPoint.

The new health care law offers some protection against plans offering overly restrictive networks, said Nancy-Ann DeParle, head of the office of health reform for the White House. Any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals, she said.

Ms. DeParle said the goal of health reform was to make sure people retained a choice of doctors and hospitals, but also to create an environment where insurers would offer coverage that was both high quality and affordable. “What the Congress and the president tried to accomplish through reform is to transform the marketplace by building on the existing system,” she said.

But most of these efforts have been limited to a small number of markets. How widespread these plans will become is anybody’s guess, and some benefits consultants wonder if these plans represent any real solution to high medical costs. The narrow network, if it is based on the insurers’ ability to demand low prices, may be “just another short-term fix,” warned Barry Schilmeister, a consultant at Mercer.

What’s more, no one is predicting a wholesale return of the classic H.M.O. as an employee’s only option of health plan. “We went through the choice battle with the managed care wars,” said Andrew Webber, the chief executive of the National Business Coalition on Health, which represents employer groups that purchase health care.

A lot has also changed in the last 15 years. The average premium for family coverage is now more than $13,000 a year, and many businesses have already asked their employees to pay a much greater share of their premiums and more of their overall medical bills.

UnitedHealth is experimenting with a more limited plan in California and Chicago and plans to expand to four or five other markets next year. Patients are allowed to see a doctor who is not in the network the insurer established, but they pay much higher out-of-pocket costs than they would in a traditional plan offering out-of-network benefits.

UnitedHealth is also starting a new plan in San Diego, which was developed for a collection of school districts, representing some 80,000 people. The plan creates tiers of doctors, and employees who use physicians deemed to offer high-quality care at low price will pay the least for their medical care.

Even large employers, worried that the new law will result in higher prices for care as government programs pay less, are reconsidering their earlier stance.

When Cigna informally asked some of its clients about their interest in these plans before the legislation passed, very few were receptive. But that has changed, said David Guilmette, a senior executive for the insurer.

One way insurers say they hope to prevent another consumer backlash is by emphasizing that they are not choosing doctors on price alone. The insurers say they look to see how quickly a doctor’s patients recover from surgery, for example. But how much the insurers emphasize quality remains to be seen.

But many insurers say they are still figuring out how to persuade people to choose these plans rather than force them to enroll. “What’s not changed are the old techniques of black-belt managed care,” said Mark T. Bertolini, Aetna’s president. “We have to create the same kind of model without the ‘Mother, may I.’ What we want is the ‘Mother, should I.’ ”

The Serious Tracking of Americans Begins They have passed the health bill, they have passed the financial regulations bill and they have snuck stuff into the stimulus package bills. They are going to track your money and your body. Here's the first few things they are doing. This is step one. It will only get worse from here.

According numismaster.com:

...the Health Care Bill mandates, according to Numismaster.com, Starting on January 1st in 2012, S federal law will require coin and bullion dealers to report to the Internal Revenue Service all gold and silver coin purchases and sales greater than $600.

No that is not an error, they tacked the gold coin tracking regulations into the health bill. They are just tacking stuff on wherever they can.

As for your body, you will be required to have an "electronic health record", by 2014. They snuck this into one of the "stimulus" bills. The electronic record will include an obesity rating. The information will be required to be on a "national exchange" with only secure access (Hah!). Why the F does your obesity rating have to be on a national exchange? This is a tip off to how micro-managed they are going to attempt to run your life.

Keep in mind that the health bill and financial "reform" bill are thousands of pages, with much of the details left up to the new agencies to fill in. Obama is appointing major league interventionists to head these agencies. They are completely clueless as to how an economy works. Their regs will be over the top. It will stifle America in so many ways, it is difficult to imagine. I was in East Berlin the year before the Wall came down. I saw what constant monitoring and micro-management did to people. It is not pretty. The gray, the drab, the despair was everywhere. When you can only take orders and wait for approvals and are constantly watched, it saps the life out of you. America is going to be changing and the government is going to try and watch you and monitor your vitals, as if you were a lab rat, as it does the changing.

Does President Obama have any idea what's in his own health-care reform law?

Since he signed the Patient Protection and Affordable Care Act a bit more than 100 days ago, the president has given a number of speeches and interviews in which he continues to say things that, well, just aren't so. Just last Friday, he told MSNBC's Chuck Todd that the law "not only makes sure everybody has access to coverage but is reducing costs."

Wrong on both counts.

The bill doesn't come close to giving "everybody" access to coverage. According to the Congressional Budget Office, 10 years from now there will still be at least 21 million uninsured Americans. That's an improvement over today, but it's a far cry from the universal coverage that Obama once promised.

And nearly half of the newly covered aren't getting access to true health insurance but are being added to the Medicaid program, with all of its attendant problems of access and quality.

Indeed, access to health care may be about to get harder. The RAND Corporation reports that the new law may result in severe overcrowding and longer waits in emergency rooms.

Meanwhile, the Centers for Medicare and Medicaid Services warn that some of the mandated cuts in Medicare could result in the closing of up to 15 percent of US hospitals.

We've already seen a near doubling in the waiting time to see a doctor under Massachusetts' universal health-care law, which is very similar to ObamaCare.

Even further from reality is the president's continued insistence that the new law is "reducing costs." In fact, the administration's own chief health-care actuary reports that the law will actually raise US health-care spending by $311 billion over 10 years. This failure to control costs means that the law will add significantly to the already crushing burden of government spending, taxes and debt.

Accurately measured, the Patient Protection and Affordable Care Act will cost more than $2.7 trillion over its first 10 years of full operation and add more than $352 billion to the national debt. This doesn't even include more than $4.3 trillion in costs shifted to businesses, individuals and state governments.

Anyone who thinks that their insurance premiums will be going down in the foreseeable future is going to be disappointed. The law Does nothing to restrain the growth in insurance costs. In fact, the Congressional Budget Office says that premiums will double over the next six years, roughly the same rate of increase as would have occurred without health-care reform.

Some workers can actually expect higher premiums. For example, according to RAND, younger and healthier Americans could see a rise of 17 percent. And the CBO says that workers who buy insurance on their own, rather than getting it via an employer, could see their premiums rise 13 percent faster than if the legislation had never passed.

Obama seems to have dropped one of his claims: the promise that if you have health insurance you like, you can keep it. Apparently, not even he could keep that one up with a straight face.

After all, just a couple of weeks ago, an internal memorandum leaked from the Obama Health and Human Services pointed out that more than two-thirds of companies could be forced to change their current coverage. For small businesses, the total could reach 80 percent.

Other reports have shown that seniors with Medicare Advantage and those workers with health-savings accounts are also likely to be forced out of their current plans. Even Americans whose plans are "grandfathered" under the law may still be forced to change coverage to a plan that meets government requirements if they make any material changes to their coverage.

As Mark Twain said, "It's not what you don't know that gets you into trouble. It's what you know for sure that just ain't so." Words of which the president should surely be mindful.

When companies are found to have violated regulations that govern their industry, is it right that a jury of non-experts can award damages the amount of which will wipe the company off the face of the earth? That is a question that has been raised in a case recently decided against Skilled Healthcare LLC of California.

A class action lawsuit (lawsuit info here) brought by trial lawyers was filed late last year against Skilled Healthcare of California claiming that the company had violated state regulations that stipulates that nursing homes must maintain 3.2 nursing hours per patient, per day (ppd). The lawsuit claimed that the nursing homes operated by Skilled Healthcare often did not meet the requirement.

Interestingly, there was never any claim from any patient that there’d been harmed or put in danger. Not a single patient claimed personal injury before these lawyers began to file their class action lawsuit.

After a six-month trial the jury decided that the company did violate the rules and awarded the plaintiffs $613 million in statutory damages and $58 million in restitutionary damages.

There is a problem with this award, however. The company only has borrowing credit of $94 million. If the company were to be held to this outrageously high award it would go bankrupt and would be forced to close its doors.

Not only that but some 32,000 people — patients/residents and healthcare workers alike — would lose their heatlhcare facilities and jobs if this award were enforced.

Does this make sense?

Now, I’ve looked at many stories about this lawsuit and cannot find any claims by the State of California that Skilled Healthcare LLC was found wanting during any of the many surprise inspections of the company’s 22 healthcare facilities. I have seen no evidence from state regulators that any citations were issued or that there has been any allegations that the nursing homes in question violated any statutes.

Skilled Healthcare has reported that it has passed all inspections. That’s notable because the healthcare industry in California is almost as highly regulated as the state’s nuclear power industry.

Yet six healthcare clients from Humbolt County, CA have been allowed the status for the levy of an award so great that it will wipe the corporation of the face of the earth?

The California Association of Health Facilities agrees that this lawsuit makes no sense. James Gomez, CEO and President of the CAHF, called the whole thing “outlandish.”

The July 6, 2010 verdict against Skilled Healthcare Group Inc. and subsidiary Skilled Healthcare LLC is outlandish, excessive and extreme. The $671 million award of damages is disproportionate to the facts of the case. It’s a by-product of a series of unprecedented and erroneous rulings of law by the trial judge, and a jury that applied the flawed rulings to the maximum extent. These maximum damages were applied over a six year period to every patient in the 22 skilled nursing facilities, regardless of whether they were named in the complaint. More importantly, the allegations specifically excluded any assertion of harm.

Gomez also laments that if the judgment stands the healthcare company will be forced to close its doors causing the loss of thousands of jobs and putting the healthcare of thousands of patients in jeopardy.

And Gomez also reports that Skilled Healthcare LLC is “widely regarded as a good provider of skilled nursing care in California and elsewhere.”

The case, now concluded, is going into a mediation phase and the company hopes that the award will be lowered to one it could actually pay instead of the punitive one that they now face.

In the end this trial is evidence that this country needs some major tort reform. Here we had a company that was going about its business, and by all accounts has a good reputation in its industry yet found itself with a multi-million dollar award levied against it because of some trial lawyers that went ambulance chasing to float a class action lawsuit. And now thousands of people’s healthcare and livelihood is in jeopardy.

What are all theses elderly patients supposed to do if the company is forced to fold? And what of all the jobs lost in this, one of the worst economies in decades?

If the company was violating state regulations on the required number of nursing staff to patient ratios, then, sure, the state should force it to comply with regulations. No one would deny that fines of some sort would legitimately be part of such a finding. But this $671 million award is not corrective, it is destructive.

And what unforeseen consequences might this award have in the healthcare industry throughout California and the rest of the country? Will it drive costs up? Will it cause smaller healthcare facilities to just close up shop for fear of giant, punitive awards for minor infractions? And what other industries might next be a target of this class action feeding frenzy?

Questions that we would not be faced with were it not for an out of control tort system.